Asplenic patient: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===Presentation=== | ===Presentation=== | ||
*Sickle-cell disease patient over the age of 8 | *Sickle-cell disease patient over the age of 8 | ||
*absent spleen on CT | *absent spleen on CT | ||
*otherwise asplenic patient | *otherwise asplenic patient | ||
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**[[Bordetella holmesii]] | **[[Bordetella holmesii]] | ||
*Viral illness | *Viral illness | ||
[[File:Asplenia.jpg|thumb|CT of an asplenic patient]] | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*CBC | *CBC | ||
*BMP | *BMP | ||
*CXR | *CXR | ||
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**Increased WBCs | **Increased WBCs | ||
**Increased platelets | **Increased platelets | ||
[[file:Splenectomyblood - Edited.jpg|thumb|Post-splenectomy blood smear demonstrating Howell-Jolly bodies and target cells.]] | |||
==Management== | ==Management== | ||
Revision as of 03:02, 3 September 2016
Background
Causes of asplenia
- Congenital
- Surgical
- Previous hypersplenism
- Sickle cell disease
- Immune thrombocytopenic purpura
- Hodgkin's lymphoma
- Thalassemia
- Hereditary spherocytosis
- Functional
Asplenia increases risk of (and worsens course of)
Clinical Features
Presentation
- Sickle-cell disease patient over the age of 8
- absent spleen on CT
- otherwise asplenic patient
If Septic
- Nonspecific symptoms
- cough
- fever
- increasing oxygen requirement
- malaise
- rash
- nausea/vomiting
- constipation/diarrhea
- urinary symptoms
- rigors
- wound infection (perhaps from dog bite)
Differential Diagnosis
- Bacterial infection (sepsis)
- Viral illness
Evaluation
Workup
- CBC
- BMP
- CXR
- Blood cultures x2
- UA w/ culture
- Wound culture, if present
- Peripheral blood smear
- Howell Jolly bodies
- Heinz Bodies
- Pappenheimer bodies
- Target cells
- Increased WBCs
- Increased platelets
Management
Sepsis
- 30mL/kg fluids
- broad spectrum antibiotics appropriate for suspected infection
- overwhelming majority of cases are from streptococcus
Fever (no sepsis)
- treat empirically with broad spectrum antibiotics
- amoxicillin-clavulanate: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
- cefuroxime: 30mg/kg per day in children divided into two doses; 500mg bid for adults
- levofloxacin 750 mg once daily (adults or adolescents only)
- moxifloxacin 400 mg once daily (adults or adolescents only)
- gemifloxacin 320 mg once daily (adults or adolescents only)
Vaccination management
- 4 doses of PCV13 before 15 months
- PPSV23 at least 8 weeks after last PCV13, first at age 2
- 2nd dose of PPSV23 3 years after first
- (if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
- (if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
- (if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
- Redose PPSV23 every 5 years
- Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
- inactivated influenza vaccine yearly
- Neisseria meningitidis vaccine for asplenic adults[1]
Prophylaxis
- Daily Penicillin VK or amoxicillin
- for children up to age of 5 or for 1 year following splenectomy
- potentially up to age of 18 for highly immunocompromised individuals[2]
Disposition
- Based on presenting complaint/illness (asplenia by itself is not an indication for admission)